Robotic Surgery Helps Teenage Singer Defeat Throat Cancer

Nick Heald was a 16-year-old singer and active member of his drama club in South Glens Falls, New York, when his drama club teacher noticed something unusual about his voice last summer.

Nick Heald

She recorded him singing and compared it to a recording of him the year before, noting that his voice had changed. The change, coupled with a persistent sore throat, prompted the teenager to visit his doctor. What doctors initially thought was acid reflux and then tonsillitis turned out to be a synovial sarcoma on the back of his tongue, a rare form of cancer that usually occurs near the joints of the arm or leg. Knowing that cancer specialists could best treat the tumor, Heald’s doctors at Albany Medical Center referred him to Boston Medical Center, the preferred tertiary care provider for head and neck cancer care in New England.

Enter Scharukh Jalisi, MD, FACS, Director, Head and Neck Surgery and Skull Base Surgery at BMC. Jalisi met with Heald, reviewed his options, and devised a treatment plan to shrink Heald’s tumor using chemotherapy and radiation and then remove it using a minimally–invasive robotic procedure called transoral robotic surgery (TORS).

Using TORS, BMC surgeons can remove both benign and cancerous tumors of the throat, larynx and neck while sparing the patient a large incision and a recovery time of several weeks. BMC was the first hospital in New England to offer this new treatment and to date, has successfully performed the procedure on 30 patients, including Heald.

Nick with his girlfriend Courtney in June 2011

“First we were able to shrink Nick’s tumor by 75 percent,” says Jalisi. “Then we used the Davinci robot to remove the tumor in one day. By using TORS, we spared Nick from a five-inch incision from his jaw to his chest, a drastic procedure that would have required cracking his jaw open to reach the cancer and a recovery time of at least two weeks. This method also allowed us to preserve speech, swallowing, and other key quality of life issues.”

To ensure the cancer was gone, Heald received follow-up chemotherapy and radiation in his home state for a short time following the surgery. That spring, he participated in his school play, “Charlie Brown,” in which he played Linus, one of the main characters. He also graduated on time with his class. Now completely cancer free, he plans to attend community college this fall.

“I’m feeling great and am back to normal,” says Heald. “Boston Medical Center was awesome. Everyone was really nice and worked well together. I’m very grateful for the care I received there.”

“Our experience was wonderful,” says Amy Gurdo, Heald’s mother. “From the moment we met Dr. Jalisi, we felt comfortable. He spelled out all the options for us, and even when he explained the worst-case scenario, we left his office feeling better. All the care Nick received, from physicians and nurses, was fabulous. We couldn’t have asked for a better outcome.”

BMC One of First Hospitals in Boston to Receive Technology Certification

In a nod to the sophistication of Boston Medical Center’s electronic health record (EHR), the hospital was recently awarded certification from the Certified Commission for Health Information Technology for its inpatient EHR suite of applications, making it only the second hospital in Boston to be certified. The approval marks the first successful step in BMC’s participation in a new federal program that provides significant financial rewards for use of EHR to improve patient care.

BMC has made a significant investment in its EHR over the past decade to improve the quality, safety and efficiency of patient care delivered here. Most recently, BMC’s Information Technology Services department (ITS) has been working on the EHR applications as the organization strives to achieve “meaningful use” later this year.

“Meaningful Use” is part of the federal stimulus bill and is designed to incentivize the use of the EHR. When a qualifying organization can show that it’s using certified EHR technology to achieve health and efficiency goals in a “meaningful way,” a significant financial incentive is awarded through federal Medicare and state Medicaid programs. Examples of the required criteria include using a certified EHR for Computerized Physician Order Entry (CPOE) and for medication reconciliation to improve quality of health care, two systems currently in place at BMC.

“Boston Medical Center is well ahead of the game,” says Eric Podradchik, Manager, BMC’s EHR team. “We have spent years working with clinicians to develop our systems and as a result, many functions already existed. We were in a great position to receive this certification and now we can move forward with the next step.”

That next step is to submit data this fall to meet the meaningful use criteria for the year. BMC then stands to gain a financial incentive of more than $20 million from the program. Even as the work is being completed, ITS is working to qualify BMC’s individual eligible providers for their participation in the Meaningful Use program.

“Our performance in this program reflects BMC’s acumen in using advanced technology to deliver exceptional, high quality care,” says Meg Aranow, Chief Information Officer and Vice President of Information Technology Services. “We are thrilled that BMC’s early investments in patient-focused technology have the added benefit of delivering financial incentives to the institution.”

Unhealthy Substance Use a Risk Factor for Not Receiving Preventive Health Services

Boston Medical Center (BMC) and Boston University School of Medicine (BUSM) researchers have identified unhealthy substance use as a risk factor for not receiving all appropriate preventive health services, such as mammography screening and influenza vaccination. These preventive health services can help reduce the rates of cancer and influenza, which area among the leading causes of mortality in the United States.

Karen Lasser, MD, MPH

Influenza is preventable, in part, through vaccination, and mortality from cervical, breast and colorectal cancer can be reduced through routine screening. Nevertheless, many eligible U.S. adults do not receive these recommended preventive services, in particular, low-income persons, racial and ethnic minorities, the uninsured and the foreign-born.

Despite this knowledge, and the implementation of interventions targeting these groups, preventive services are still underused.

According to the researchers, future interventions to promote mammography screening might target women with unhealthy substance use, and those to promote influenza vaccination might target both men and women with unhealthy substance use.

“Clinical interventions could embed mammography screening and influenza vaccination in other services delivered to individuals with substance use problems,” says lead author Karen Lasser, MD, MPH, a primary care physician at BMC. “In addition, training interventions could enhance skills and systems for health care personnel who screen for substance use disorders to include referrals for preventive health services.”

What Do You Do, Dona Rodrigues?

What brought you to BMC?I joined the staff in 1994 as a nurse midwife practicing full scope midwifery in the community. Previously I was employed by the Boston Public Health Commission, working with vulnerable populations, so coming to BMC was a natural transition. In 1999, the director of the midwifery program here approached me to attend the program, which I did and loved. I’ve been here ever since.

What do you do here?Two years ago, I became the director of BMC’s Birth Sisters Program, which is a multi-cultural doula service that trains women from the community to give social support to at-risk prenatal mothers during the prenatal period, as well as during labor, birth and post-partum. The sisters then connect mothers to social resources. The program is busy, serving 30-35 women a month. My time is usually spent at Uphams Corner Health Center, where I work with mostly Cape Verdean and Spanish-speaking women during their obstetrics and gynecological sessions. I also enjoy a few shifts a month delivering babies on the labor floor in the Menino Pavilion.

Why do you stay at BMC? This is home. The fact that I’ve been here for so long speaks for itself and shows that I still feel passionate about birth and I am committed to the BMC community. It’s the type of work that has to come from within since you have to give so much of yourself. It’s not a nine-to-five job and those whom I work with go above and beyond. I love my job and can’t see myself anywhere else.

What do you like to do in your free time?I enjoy jazz and go to concerts often. I also love salsa dancing!

In Their Words

Patients share their BMC experience

My husband was a patient in Newton Pavilion this past weekend. He had surgery for an odontogenic keratocyst and this was his second admission for this problem.

I am a nurse with 40 years of experience and the nurses that my husband had were phenomenal. Mary was his night nurse and made us feel so welcome and the fact that I and my sister-in-law (we both stayed overnight) were in the room did not hinder his care at all. She was so kind and thoughtful. It is hard enough to care for the patient, never mind two overbearing family members. Then we had Tammy for the day shift. She was equally as nice and thoughtful and made sure we were aware of any changes made to my husband’s care. I felt comfortable enough with the care he was receiving that I left to go home for a few hours. We were glad to see the return of both nurses the next night/day. They made sure we felt welcome and comfortable and gave exceptional care. I also felt that your staff on both shifts worked well together; Joan, on at night, came in to check on us when Mary was tied up, and the same with the day staff.

I could go on and on, but the bottom line is, thanks to the thoughtfulness and caring of these two nurses, our experience was great and we needed that. It was exceptional care without exception.

News of Note

Carl and Ruth Shapiro withBMC President and CEO Kate Walsh

Shapiro family visits BMC’s new ambulatory centerCarl and Ruth Shapiro, along with their daughter Ronny Zinner, recently visited BMC’s new Carl J. and Ruth Shapiro Ambulatory Care Center for a tour with BMC President and CEO Kate Walsh. The building, which opened in April, is named after the Boston philanthropists in recognition of their $15 million gift to BMC.

Hochberg named Vice President for Quality and Patient Safety/Chief Quality OfficerStanley Hochberg, MD, currently Chief Medical Officer at BMC HealthNet Plan, assumes the role of Vice President for Quality and Patient Safety/Chief Quality Officer at BMC on Oct. 1. In this role, Hochberg will lead BMC's health care quality and safety programs, with the charge of continuing to improve the effectiveness, efficiency, safety, and timeliness of inpatient and outpatient care. He will oversee and manage the hospital's quality improvement, performance improvement, risk management, quality measurement and infection control functions.

Hochberg is Chairman of the Board of Massachusetts Health Quality Partners, a coalition of physicians, hospitals, health plans, consumers, academics, and government agencies working together to promote improvement in the quality of health care services. He has served as Chief Operating Officer and Medical Director at the Care Group Provider Services Network, where he developed sophisticated quality intervention systems for network physician groups, and Vice President and Regional Medical Director at Harvard Pilgrim HealthCare.

Biggio named Vice President of Facilities and Support ServicesRobert Biggio joins BMC as Vice President of Facilities and Support Services on Sept. 6. Biggio previously worked for 10 years at Massachusetts Eye and Ear Infirmary where he served as Vice President Support Services and Real Estate for the past three years. Biggio has more than 15 years of facilities management and support services leadership experience and a technical background in engineering and facilities management. As Vice President of Facilities and Support Services, Biggio will oversee Facilities, Environmental Services, Food & Nutrition and Transport Services at BMC.

BMC scores well on patient safety surveyBoston Medical Center is a patient safety leader among Boston hospitals. BMC recently participated in its first patient safety survey through the Leapfrog Group, a consortium of Fortune 500 companies working to leverage improvements in health care quality and patient safety. The group surveys U.S. hospitals on their performance in six areas:

Adoption of computer physician order entry (CPOE) systems;

Use of referral hospitals that provide certain high-risk surgeries and treatments;

Heart attack and pneumonia outcomes;

Incidence of hospital-acquired infections and injuries;

Round-the-clock staffing of intensive care units with doctors and nurses trained in critical care medicine; and

Implementation of additional practices that can reduce the number of preventable medical errors.

Lassonde represents BMC at Making Strides breakfastDiane Lassonde, Executive Assistant, BMC’s Department of Radiation Oncology, recently attended the kickoff breakfast for the 19 th annual American Cancer Society Making Strides Against Breast Cancer walk in Boston. The walk attracts 40,000 people who participate in the largest one-day walk to fight breast cancer in the nation on Oct. 2 at the DCR Hatch Shell in Boston.

Lassonde, second from left, at the Making Strides breakfast

Lassonde, a strong supporter of breast cancer research, attended the breakfast as a BMC representative. Pictured, from left to right, are event emcee Dylan Dreyer of 7News on 7NBC/CW56; Lassonde; Angela Hall Jones, American Cancer Society Community Executive for Health Initiatives; and co-emcee Candy O’Terry, of MAGIC 106.7.

William Kannel, MD, leader of Framingham Heart Study, diesWilliam Kannel, MD, a pioneer in cardiovascular epidemiology and past chief of the Section of Preventative Medicine at Epidemiology at Boston University School of Medicine, died on Aug. 20, of cancer. Kannel served as the principal investigator of the world famous Framingham Heart Study, long considered the leader in cardiovascular epidemiologic research, from 1979 to 1987. He continued work as the senior-most investigator at the Heart Study until his illness curtailed those efforts. Learn more.

Awards and Accolades

Daniel Alford, MD, MPH, Primary Care, and Steve Williams, MD, Chief, Chairman, Rehabilitation Medicine, have been named winners of the 2011 Rx for Excellence Awards, which honor best practices in medicine. Alford and Williams are recipients of Heroes from the Field awards, which will be presented at an awards ceremony on Nov. 4. The fourth annual awards ceremony and breakfast celebrates patient safety, health care quality and risk management.

BMC/BUSM's medical education and neurology residency training programs have been ranked among the top 20 of 120 U.S. programs according to a study published in the August issue of the Archives of Neurology. The analysis, conducted by researchers, assessed the impact of medical schools and residency training programs on the decision to pursue a career in academic neurology as well as an estimation of the most productive medical schools and residency programs based on the academic productivity of their respective graduates.